Challenges and Opportunities in Recruiting Minority Blood Donors in Pluralistic Societies: the Case of Montreal, Canada

Challenges and Opportunities in

Recruiting Minority Blood Donors in

Pluralistic Societies: the Case of

Montreal, Canada

Research Chair on the Social Aspects of Blood Donation

Funded by the Héma-Québec Foundation

Montreal, Quebec, Canada

Nathalie Tran

Johanne Charbonneau Valeria Valderrama-Benitez Geneviève Lacroix

Blood Donation – 2.1 Blood Donor Recruitment Session Blood Donors I: Donor Motivation 4D-S28-03

Research Project on Minority Communities

and Blood Donation in Québec

Why study minority donors and their communities?

In Montreal, Canada, as in many ethnically and culturally diverse societies, minority donors tend to give proportionally less blood than the majority population (Boulware et al. 2002; Glynn et al. 2006; Grossman et al. 2005; Murphy et al. 2009; Price et al. 2009; Shaz et al. 2010);

Though numerous authors have attempted to look at the underlying factors of this reality

(Steele et al. 2008; Glynn et al. 2006; Schreiber et al. 2006; Nguyen et al. 2008), only a handful (Alessandrini 2006; Alessandrini et al. 2007; Grassineau et al. 2007; Hollingsworth et al. 2004; Sampath 2007; Umeora et al. 2005; Misje 2005) have focused on the

socio-cultural narratives and expressions of what is, in the end, a socially grounded and symbolically charged act.

Objective of the study

To qualitatively examine motivations, practices and cultural beliefs of minority donors and their communities so as to better understand the socio-cultural background of blood donation in order to develop strategies to seek their collaboration and recruit more donors of diverse origins.

Introduction

The study and the methodology Some immigration statistics

The organizational model of blood collection in Quebec

Part I: Minority partners and community leaders

Current minority partners Ideal minority partners Potential minority partners

Part II: Minority donors

Minority donors’ motivations Blood, family and community

Reluctance and barriers to blood donation

Conclusions and recommendations

Introduction

Methodology

Our research team has conducted 84 1 ½ hour long semi-structured qualitative interviews with:

a) 32 blood donors from an array of backgrounds such as Chinese, Vietnamese, Caribbean, African, Latin-American and Middle Eastern as well as from various religious settings, including Christian, Muslim, and Buddhist;

b) 6 Héma-Québec representatives who work with minority blood drive partners; c) 46 leaders from minority communities (associations/churches):

-9 of whom are already holding blood drives (Héma-Québec partners)

-37 of whom do not currently organize blood drives

Interview guides

Some immigration statistics

Canada

(population 31,241,030)

16, 2% of Canada’s population belongs to a minority group

Of those, 95, 9% live in a metropolitan area, compared to

68, 1% for the whole population.

Montreal

(population 3,588,520)

In Montreal, Canada’s second largest city, close to 90% of minorities live in the metropolitan area (almost 77% of them live on the Island of Montreal)

Apparicio 2008 Statistics Canada 2006

The Organizational Model of Blood Collection in Quebec

All donations are unpaid, anonymous and volunteered by the population.

86% of the blood supply is obtained through 2000 annual mobile blood drives across the province (Héma-Québec 2009)

These mobile blood drives are organized on a volunteer basis, usually

by community associations, municipal services, the educational sector or local enterprises. There are more than 16,000 blood drive volunteers (Charbonneau et al. 2010)

The drives’ outcome rest on the shoulders of the community. This collection system is often credited for Héma-Québec’s enviable blood bank, which maintained an average of 10,2 days inventory in 2008-2009 (Héma-Québec 2009).

Our research has shown that minority donors frequently give blood within the framework of school (post-secondary education) or in the work environment

School and workplaces are limited in scope.

There is a need to target minority donors in other settings.

In Quebec, only 1% of community blood drives are held in partnerships with minority associations which indicates that more can to be done to involve them.

Part I:

Minority partners and community leaders

Who are the current minority community partners?

- All partners initiated contact with Héma-Québec - A majority are cultural or religious groups

- Their intentions in seeking to collaborate with the agency on blood drives:

To commemorate a particular political or religious event in their community;

To fight perceived discrimination against members of their community by engaging in a citizen event.

Marwan, a Christian Lebanese leader:

Karim, a Muslim leader:

“We organize the blood drive to celebrate…to remember our martyrs [of the civil war].I don’t want to forget their sacrifices and neither does the Lebanese community. Some people hold church services, other people organize a party but we hold an event where people can give...Personally, I cannot give blood but that doesn’t mean that I cannot volunteer, that I cannot organize the event and encourage healthy people to donate. It’s also a way to show our integration into Canadian society, that we aren’t parasites, that we’re not only here to work, sleep and eat: we have a noble social involvement. I call it noble work.”

“People who aren’t from the community cannot understand,but we are discriminated against. There are two ways to

fight discrimination: by countering it legally [in court]...or by doing so positively, by integrating ourselves fully [into society]. So, the association decided to contact Héma-Québec”.

Ideal partners

The most successful drives are by well-organized communities with a

strong sense of identity and a broad mobilization capacity, who hold

blood drives for commemorative purposes

Characteristics of ideal minority partners

Strong sense of identity; Broad mobilization capacity;

Intention in holding a blood drive not only altruistic in nature but also socially, culturally, religiously or politically driven;

Volunteers are supported by their leaders and members of their community; Members of their association are able and willing to give blood;

Potential partners

What do minority leaders have to say about blood donation?

About organizing blood drives?

Unaware of how blood donation works in Quebec

In country of origin: replacement blood for family members or friends / donation at hospital, clinical setting or permanent center

In Quebec: collective blood bank for distribution to strangers / mobile blood drives / non-hospital settings such as community centers

No immediate urgency

No war

No natural catastrophy

No calls made out to the population No family members undergoing surgery

Perception of exclusion

For some minority leaders, the feeling of exclusion from society is a deterrent to participating in blood drives

NO NEED FOR

BLOOD

Part II:

Minority Donors

Fostering blood donation by understanding donors’

socio-cultural background

Why do minority donors give blood?

Like other donors, they see blood donation as a civic duty, give blood for the common good and want to contribute to saving a life(Fantauzzi 2008; Javadzadeh 2006; Mathew et al. 2007; Steele et al. 2008);

More specifically, some were previously acquainted with blood donation in their country of origin, have been in situations that has made them aware of the need for blood (i.e. relative or friend needing a blood transfusion) or have lived through times of great need, such as war;

More precisely, some find that blood donation has health implications: they want to offer the gift of health for someone in need; giving blood reassures them of their overall state of health and; they believe that by giving blood, they might benefit from the regeneration of their own blood;

Minority donors who give in school or work environments not only find it a convenient but are positively encouraged by their fellow students or colleagues.

Blood, family and community

Giving blood to family and friends

If given the choice, many potential minority donors would be more inclined to give blood to a relative (or a friend) than to complete strangers;

Most were surprised that giving blood to a family member, in case of emergency, was generally not possible in Quebec.

Giving blood to one’s community

English-speaking Caribbean informants are more inclined to give blood to their own community (as well as to family members and friends) than to complete strangers partly because of perceived double discrimination (Black and English- speaking) in a white and French-speaking society.

Mistrust in public health institutions

Historical mistrust in public health institutions -Tuskegee experiment- (Callender et al. 2001; Gamble 1997; Petersen 2002);

Resentment toward public health institutions for the blood scandal in the 1980s which barred Haitians to donate blood;

Informants of African and Caribbean origins believed their blood would not be used even if accepted at the drive.

Reluctance and barriers to blood donation

Lack of information regarding blood donation procedure

How does blood donation work in Quebec? Where are blood drives held?

How safe is it to give blood?

What happens to blood after it is donated?

Potential minority donors do not feel personally concerned by the cause

No social encouragement

Blood donation is often thought of as an individual act and unlikely to be a topic of conversation

The influence of folk medicine: maintaining balance within the body

Blood is seen as a vital fluid, a source of life (Camporesi 1995; Du Boulay 1984; Meyer 2005; Nabofa 1985; Nelkin 1999; Roux 1988 );

Folk medicine in many regions and cultures, such as for the Caribbean, Chinese and Vietnamese dictates that balance within the body will help maintain overall health, and therefore discourages giving bodily fluids away (Bray 1999; Holroyd et al. 2000; Kristy 1998; Laguerre 1987; Larre et al. 1999; Maher et al. 2009; Mok Chan 1978; Sobo 1993; Tison et al. 2007; Zaller 2005).In this frame of mind, giving blood is almost seen as a sacrifice.

Conclusion and recommandations

Focus on festiveness and conviviality during the blood drives

Allocate a budget for the volunteering group to prepare or buy food. Suggest foods which they might consider helpful for blood regeneration.

Make it a social event

Previous research in Quebec has shown that volunteers get involved and stay involved because they enjoy the social event aspect of the blood drive(Charbonneau et al. 2010);

Encourage leaders and organizers to treat the blood drive as a social event rather than a chore.

Personalize the event

Discuss the possibility of holding the blood drive as a community event, celebration or commemoration.

Turn it into a habit

Discuss the possibility of integrating the blood drive into the group’s annual calendar, making the event recurrent. Long-term minority partners often mentioned that they continued organizing blood drives because it had become a habit to do so every year.

Conclusion

Get religious leaders on your side

Most world religions uphold altruitics values and religious leaders are often willing to lend a hand and initiate community discussion on topics such as blood donation;

As respected members of their community, they will reassure and most likely encourage potential donors to give blood.

Use ethnic media to target minority donors

Traditional media rarely compellingly reaches potential minority donors;

Advertisement should be adjusted to the knowledge and beliefs of various communities and appear in ethnic media, where potential donors are more likely to see or hear it.

Develop the blood agency’s cultural competence

Train personel to be sensitive to cultural diversity and make it easier for minority donors to navigate through the process (languages spoken at the blood drive, time taken for new donors and for explaining refusals, etc.)

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